Tanzania

*Only appropriations from the GHCS (State) fund account are notified by the Global AIDS Coordinator.

The United Republic of Tanzania (URT) faces many economic and social development challenges, including those posed by a generalized AIDS epidemic and other communicable diseases. Critical impediments to strengthening health outcomes in Tanzania include the inadequacy of trained human resources, inadequate infrastructure, and overburdened logistics systems and supply chains. In March 2010, the U.S. Government and URT signed a PEPFAR Partnership Framework. Overall, the Framework aims to reduce new HIV infections and morbidity and mortality due to HIV and AIDS and improve the quality of life for those affected by HIV and AIDS. The PF focuses on six goals: service maintenance and scale-up; prevention; leadership, management, accountability, and governance; sustainable and secure drug and commodity supply; human resources; and evidence-based and strategic decision-making. The Partnership Framework documents are now available at: http://www.pepfar.gov/frameworks/tanzania/index.htm.

The URT’s stated top HIV/AIDS priority is to reduce the number of new HIV infections. With FY 2010 funding, sexual prevention implementing partners will work closely to implement coordinated programs with consistent messages on VMMC, cross-generational and transactional sex, alcohol, condom use, gender norms, and other drivers. PEPFAR also supports prevention programs for MARPS, including CSWs, IDUs, and MSM. VMMC services will be scaled up in 2010, and PEPFAR will continue to support PMTCT, safe blood services, and injection safety.

Since 2004, the number of PEPFAR-supported care and treatment clinics has grown from 15 to 605 in 2009. The Tanzanian National Costed Plan of Action outlines specific needs of Most Vulnerable Children by geographic area and identifies resource gaps for meeting these needs. Considerable progress has been made in the scale-up of direct supportive services by reaching 370,954 OVC.

Rapid national scale-up of HIV services benefitted from a regionalization strategy initiated by the Ministry of Health and Social Welfare (MOHSW) in FY 2006, yielding broad geographic coverage, de-duplicated efforts, and maximized efficiency of implementing partners. As a result, PEPFAR treatment partners have now taken on the responsibility for the implementation of a variety of clinical services. Because of this coordinated support, PEPFAR expects to see continued improvements in referrals and linkages between services and an increase in the provision of more efficacious ART regimens to HIV-infected pregnant women.

PEPFAR will continue to work with the MOHSW to conduct a feasibility appraisal in the context of the new WHO treatment guidelines. Findings will inform URT consideration of changing treatment guidelines Tanzania. An ART costing study has been undertaken in Tanzania; preliminary results indicate that the proposed funding for FY 2010 will be sufficient to meet immediate care and treatment targets.

PEPFAR-supported activities in systems strengthening will sustain the responsible transition of PEPFAR programs to the URT and to local partners. PEPFAR has targeted key elements of the health system: procurement and supply chain; management capacity of national, regional, and district health teams; HRH; lab services; and SI. The Tanzania Field Epidemiologist and Laboratory Training Program will continue training field epidemiologists and public health field laboratory managers to serve as leaders in surveillance and the public health response. Conflicting opinions among high-level URT officials on task shifting will require that PEPFAR advocate vigorously in FY 2010 for a more open perspective on task shifting. During FY 2010, a review will assess whether existing programs appropriately prepare professional health managers and administrators to effectively manage health service delivery and resources, and to achieve task shifting goals.

Programming around the additional Partnership Framework funding was developed under the national scale-up scenario that recognizes Tanzania's progress in the fight against HIV and AIDS as well as the ongoing financial and capacity constraints. The Partnership Framework is designed to support Tanzania's HIV and AIDS programs, fortify structures in the underlying health system and strengthen in-country leadership and management capacity to oversee and manage the national response.

These funds have been programmed within the context of the Partnership Framework Implementation Plan, which has been submitted for stakeholder review. The Team used the following guiding principles while programming funds to fit within the contect of the PFIP: 1) Focus on building and strengthening local capacity, 2) Promote strengthening of the health system by increasing long-term viability and sustainability of the program in each technical area, 3) Build synergies with other resources, including Global Fund, PPPs, and wraparounds with other USG programs, and 4) Increase efficiencies in existing programs to maximize impact.